Mental health consequences for survivors of the 2011 Fukushima nuclear disaster: a systematic review. Part 1: psychological consequences

Disaster-related deaths with alcohol-related diseases after the Fukushima Daiichi nuclear power plant accident: case series

Introduction

The health of patients with mental disorders, such as alcohol-related diseases, often deteriorates after disasters. However, the causes of death among those with alcohol-related diseases during and after radiation disasters remain unclear.

Methods

To minimize and prevent alcohol-related deaths in future radiation disasters, we analyzed and summarized six cases of alcohol-related deaths in Minamisoma City, a municipality near the Fukushima Daiichi nuclear power plant.

Results

Patients were generally treated for alcohol-related diseases. In one case, the patient was forced to evacuate because of hospital closure, and his condition worsened as he was repeatedly admitted and discharged from the hospital. In another case, the patient's depression worsened after he returned home because of increased medication and drinking for insomnia and loss of appetite.

Discussion

The overall findings revealed that, in many cases, evacuation caused diseases to deteriorate in the chronic phase, which eventually resulted in death sometime after the disaster. To mitigate loss of life, alcohol-related diseases must be addressed during the chronic phases of future large-scale disasters, including nuclear disasters.

Community's perception of lockdown ascribed to the COVID-19 pandemic

Background

The COVID-19 pandemic caused a mandatory nationwide lockdown from March 24, 2020. In this difficult and unprecedented time, the requirement to adapt to lockdown and a forced stay-at-home had an impact on people's lives.

Aim

Community's perception of lockdown ascribed to COVID-19 pandemic.

Materials and Methods

A cross-sectional study was done on individuals aged 18 and above across India, to assess their perception regarding lockdown due to the COVID-19 pandemic. The study was carried out using a semi-structured questionnaire, where the data were collected via Google Forms and analyzed via Epi info 7. The questionnaire comprised of how individuals perceived the lockdown, and how COVID-19 news circulating on various social media platforms and news channels affected their mental health.

Results

The study included a total of 552 individuals. The study found that the lockdown was supported by 47% of respondents. 69.9% participants acknowledged that during lockdown, a huge amount of COVID-19 news was being disseminated, while 67.2% of individuals were overly preoccupied with thinking about preventative measures. As a result of being confined indoors, 59% of respondents thought their screen time had increased.

Conclusion

Respondents perceived that the lockdown had its benefits and drawbacks. They were impacted by the flood of information from various social media platforms as well and there was an increase in screen time.

Effects of low-dose/high-dose-rate X-irradiation on oxidative stress in organs following forced swim test and its combined effects on alcohol-induced liver damage in mice

The liver's susceptibility to oxidative stress after a combination of forced swim test (FST) and low-dose-rate γ-irradiation has been observed. Therefore, this study aims to clarify the effects of low-dose (0.1 and 0.5 Gy)/high-dose-rate (1.2 Gy/min) irradiation on combined oxidative stressors-liver damage associated with FST and alcohol administration. In addition, the effects of similar irradiation on FST-induced immobility, which induces psychomotor retardation, and antioxidative effects on the brain, lungs, liver and kidneys were investigated, and the results were compared with those of a similar previous study that utilized low-dose-rate irradiation. Low-dose/high-dose-rate (especially 0.5 Gy) irradiation temporarily worsened liver antioxidant function and hepatic function with FST- and alcohol administration-related oxidative damage; however, the damages improved soon after. In addition, the increase in total glutathione content in the liver contributed to the early improvement of hepatic functions. However, pre-irradiation did not suppress immobility during the FST. The results also suggested that the effects of low-dose/high-dose-rate irradiation on the antioxidant functions of each organ after the FST were different from those of low-dose/low-dose-rate irradiation. Overall, this study provides further insights into the effects of low-dose irradiation on exposure to a combination of different oxidative stressors. It will also contribute to the elucidation of dose rate effects on oxidative stress in the low-dose irradiation range.

[Clinical and psychological characteristics of people with prenosological forms of alcohol consumption residing in radioactively contaminated territories of the Southern Urals]

OBJECTIVE

To identify clinical and psychological features of people with prenosological forms of alcohol consumption residing in radioactively contaminated territories (RCT).

MATERIALS AND METHODS

Seventy-eight people born in 1960 and earlier with prenosological forms of alcohol consumption residing in RCT took part in the study. They composed 2 groups: Group I (people (n=37) postnatally exposed to combined external and internal radiation), Group II (people (n=41) not exposed to radiation). The groups are comparable for age and sex. Clinical, polling, clinical/ psychological and statistical methods were used.

RESULTS

People with excessive (risky) levels of alcohol consumption (p=0.041) are statistically significantly more often identified in group 1. Noting relatives who abuse alcohol, people from this group consider a brother (p=0.042) and highlight residence in the RCT, as one of the factors affecting their health (p=0.025). They believe that moving to an ecological clean area will improve their health (p=0.039).

CONCLUSION

Alcohol abuse can be a predictor of the development of alcohol dependence in the exposed population, which predetermines the need to develop and implement preventive measures aimed at preventing the transition from prenosological forms of alcohol consumption to alcohol dependence.

Mental health and psychosocial consequences linked to radiation emergencies-increasingly recognised concerns

A major radiological or nuclear emergency may, apart from causing a substantial loss of life and physical damage, also put a substantial strain on affected societies with social, economic and political consequences. Although such emergencies are relatively uncommon, it is now being increasingly recognised that their subsequent psychosocial impact can be widespread and long lasting. Mental health effects, such as depression, anxiety and post-traumatic stress disorder, are highly represented in a population affected by a radiation disaster. In order to reach the majority of the people affected by radiation accidents, we need to be aware of how to distribute relevant and accurate information related to both short- and long-term medical effects. Effective risk communication is associated with improved compliance with any given recommendations. It is important to protect the public from physical radiation damage, but it is also essential to take into account the social and mental health effects that radiation disasters may induce. This article provides a brief review of recent reporting on the psychological consequences after a major radiation emergency.

Visualizing the decline of public interest in the Great East Japan Earthquake and Fukushima Daiichi nuclear power plant accident by analyzing letters to the editor in Japanese newspapers

This study aimed to delineate the decline in public interest toward the March 2011 Great East Japan Earthquake (GEJE) and the Fukushima Daiichi nuclear power plant (FNPP) accident in Japan over a ten-year period. In this longitudinal descriptive study, we searched for publications within a ten-year period in Letters to the Editor that mentioned the GEJE, the FNPP accident, or the January 1995 Great Hanshin-Awaji Earthquake (GHAE) that occurred in Japan, using the official databases of the three largest Japanese newspapers. The GEJE- and GHAE-related publications (4,809 and 2,092, respectively) are depicted as scatter plots. The results show a gradual decrease in the publications mentioning GEJE or GHAE. The impact of GEJE and FNPP on Japanese society was enormous, but the public interest waned over time. Communication strategies that maintain a high public interest in previous disasters may be necessary.

Social and Mental Health Impact of Nuclear Disaster in Survivors: A Narrative Review

This narrative review synthesizes the literature on the psychological consequences of the Three Mile Island nuclear accident of 1979, the Chernobyl nuclear disaster of 1986, and the Fukushima nuclear disaster of 2011. A search was conducted on OVID for studies in English from 1966 to 2020. Fifty-nine studies were included. Living through a nuclear disaster is associated with higher levels of PTSD, depression, and anxiety. Decontamination workers, those living in closest proximity to the reactor, and evacuees experience higher rates of mental health problems after a nuclear disaster. Those with greater psychological resilience and social supports experience lower rates of psychological distress. Individual-level interventions, such as mindfulness training, behavioral activation, and cognitive reappraisal training, have shown modest benefits on improving psychological wellbeing. At the population level, many of the measures in place aimed at reducing exposure to radiation actually increase individuals’ anxiety. Technology-based supports have been studied in other types of natural disasters and it may be beneficial to look at mobile-based interventions for future nuclear disasters.

An ethical dimension to accident management and health surveillance

Many radiation protection actions carry a multitude of direct and indirect consequences that can impact on the welfare of affected populations. Health surveillance raises ethical challenges linked to privacy and data protection, as well as questions about the net benefit of screening. The SHAMISEN project recognized these issues and developed specific recommendations to highlight ethical challenges. Following a brief overview of ethical issues related to accident management, this paper presents the SHAMISEN recommendations: R1 The fundamental ethical principle of doing more good than harm should be central to accident management; and R4 Ensure that health surveillance respects the autonomy and dignity of affected populations, and is sensitive to any inequity in the distribution of risks and impacts. While a holistic approach to accident management means that decisions will be complicated by different values, perceptions and uncertainties about outcomes, addressing ethical issues could help ensure that the assumptions and potential conflicts behind eventual decisions are as transparent as possible.

Mental Health Consequences of the Three Mile Island, Chernobyl, and Fukushima Nuclear Disasters: A Scoping Review

Many individuals who were affected by the Great East Japan earthquake and tsunami and the subsequent Fukushima Daiichi Nuclear Power Plant accident continue to face a challenging recovery. We reviewed the long-term mental health consequences of three major nuclear power plant accidents: the Three Mile Island (TMI, 1979), Chernobyl (1986), and Fukushima (2011) nuclear disasters. We examined the relevant prospective cohort studies and before-and-after studies that covered more than two timepoints, searching four databases (PubMed, Ichushi, PsyArticles, and PTSDPub). We identified a total of 35 studies: TMI, n = 11; Chernobyl, n = 6; and Fukushima, n = 18. The smaller numbers of early-phase studies (within 6 months) of the Chernobyl and Fukushima disasters may also indicate the chaotic situation at those timepoints, as large-scale interviews were conducted in the early phase after the TMI disaster. Although the patterns of effects on mental health outcomes were diverse, more than half of the participants in the studies we evaluated were categorized into low or under-threshold symptom groups in all three disasters. Across the three disasters, the radiation exposure level estimated by the proximity and stigma were the common risk factors for mental health outcomes. Our findings will contribute to a comprehensive understanding of the impact of the worst nuclear accidents in history on the affected individuals' mental health, and our results illustrate the longitudinal consequences of such disasters.

Mental Health and Neuropsychiatric Aftermath 35 Years After the Chernobyl Catastrophe: Current State and Future Perspectives

OBJECTIVE

The Chernobyl nuclear power plant (ChNPP) disaster that happened in Ukraine on the 26th of April 1986 still represents the most severe nuclear accident in human history. Its consequences, especially those involving mental health are increasingly emerging as long-term detrimental effects. Therefore, the aim of the present paper was to review the results of some of authors' studies and their personal reflections on this topic.

METHOD

The authors selected and commented on the findings mainly derived from their contributions on the prevalence of long-term psychopathological symptoms and neuropsychiatric disorders in diferent groups of exposed and non exposed individuals, including the workers at the NPP the so-called liquidators (CUWs), the most exposed group, evacuees and people living in more or less contaminated areas.

RESULTS

The main findings derived from a series of studies carried out by the authors throughout the following decades after the disaster indicate the high prevalence of cerebrovascular diseases, organic mental and depressive disorders, cognitive impairment and even dementia that increase with the irradiation dose mainly amongst the liquidators. The organic disorders are probably related to a peculiar effect of radiation on left, dominant brain hemisphere. Interestingly, recent studies revealed abnormalities of the serotonin transporter and other genes disorders possibly at the basis of depression of exposed individuals.

CONCLUSIONS

The high prevalence of neuropsychiatric disorders amongst irradiated subjects following the ChNPP disaster highlights the impact of radiation exposure on the lifelong onset of neuropsychiatric disorders, for too long neglected by international agencies. Such findings require to be deepened in the future possibly within the frame of the so-called "ecological psychiatry".

Psychological impact and social support in pregnant women during lockdown due to SARS-CoV2 pandemic: A cohort study

Introduction

Anxiety and depression during pregnancy can lead to adverse maternal and neonatal outcomes. The SARS CoV‐2 pandemic, and the complete lockdown required during the first wave in most countries are stressors for pregnant women and can lead to anxiety and depression during pregnancy. The aim of this study was to explore depression and anxiety symptoms, and social support in pregnant women during the SARS CoV‐2 lockdown, as well as to explore demographic risk factors.

Material and methods

A prospective cohort study was performed at Hospital Universitari Vall d’Hebron, Barcelona, including pregnant women attending the antenatal clinic during the SARS‐CoV2 lockdown period. Three questionnaires were administered to study depression (EPDS), anxiety (STAI) and Social Support (MOS‐SSS). STAI state (STAIs) described the actual state of anxiety and the STAI trait (STAIt) described the trait of anxiety. A cut‐off of 10 for EPDS and 40 for STAI was considered to be clinically relevant. The main outcome measures were depression and anxiety symptoms.

Results

A total of 217 women were invited to participate, and 204 accepted (94%). From these, 164 filled in the EPDS, 109 STAI and 159 MOS‐SSS questionnaires: 37.8% (95% confidence interval [CI] 30.5%‐45.7%) (62/164) of women showed an EPDS result ≥10, 59.6% (95% CI 49.8%‐68.8%) (65/109) a STAI state (STAIs) ≥40, and 58.7% (95% CI 48.9%‐67.9%) (64/109) a STAI trait (STAIt) ≥40. Regression analysis showed that mental health disorder, Latin American origin and lack of social support were independent risk factors for anxiety symptoms in the STAIs (P = .032, P = .040 and P = .029, respectively). Regarding depressive symptoms, maternal body mass index, mental health disorders and social support were independent factors (P = .013, P = .015 and P = .000, respectively).

Conclusions

A lockdown scenario during the first wave of the SARS‐CoV 2 pandemic increased the symptoms of anxiety and depression among pregnant women, particularly affecting those with less social support.

Effect of WeChat consultation group on residents staying at home in Sichuan and Chongqing regions during the Coronavirus Disease 2019 (COVID-19) outbreak in China: a cross-sectional study

Background

After the outbreak of Coronavirus in Wuhan, Hubei, in 2019, the disease rapidly spread to other parts of China as well as outside of China. Since the pandemic outbreak, the general public has been responsive to the national call to stay at home in quarantine. However, since doubts and anxiety related to the disease have been detected in the general public, in this study, we established the WeChat platform “Coronavirus Disease 2019 Voluntary Assistance Group in Sichuan and Chongqing regions” in January 2020, which was committed to providing professional consultation and psychological counseling services for residents in Sichuan and Chongqing during the Coronavirus Disease 2019 outbreak. Our aim was to analyze the consultation practices of residents in the WeChat assistance group and provide a reference for the similar “non-contact” voluntary service platforms aiming to implement consultations during the late pandemic period.

Methods

A cross-sectional study was conducted using the records containing the consultation content from the WeChat assistance groups in Sichuan and Chongqing between January 30 and March 1, 2020. Data on consultation content, changes in a number of consultation items, answers, knowledge on popular science, and expert advice were summarized, and the Pareto chart was used to analyze the primary and secondary factors of consultation content.

Results

The constituent ratio of “respiratory symptoms, masks, and disinfection” in consultation content ranked as the top three factors. Cumulatively, they occupied 49.77% of the content, thus resulting as the primary factors in the consultation content. The number of consultation items suddenly increased from 10 on the first day to 116 on the 7th day, resulting in a 1060% increased rate. There were 151 consultation factors, among which 130 (86.1%) were related to the Coronavirus Disease 2019, and 21 (13.9%) were unrelated to the Coronavirus Disease 2019.

Conclusion

WeChat groups may be used as an effective means for providing assistance services for the public during the Coronavirus Disease 2019 outbreak.

Effects of the lockdown on the mental health of the general population during the COVID-19 pandemic in Italy: Results from the COMET collaborative network

BACKGROUND

The Coronavirus disease 2019 (COVID-19) pandemic is an unprecedented traumatic event influencing the healthcare, economic, and social welfare systems worldwide. In order to slow the infection rates, lockdown has been implemented almost everywhere. Italy, one of the countries most severely affected, entered the "lockdown" on March 8, 2020.

METHODS

The COvid Mental hEalth Trial (COMET) network includes 10 Italian university sites and the National Institute of Health. The whole study has three different phases. The first phase includes an online survey conducted between March and May 2020 in the Italian population. Recruitment took place through email invitation letters, social media, mailing lists of universities, national medical associations, and associations of stakeholders (e.g., associations of users/carers). In order to evaluate the impact of lockdown on depressive, anxiety and stress symptoms, multivariate linear regression models were performed, weighted for the propensity score.

RESULTS

The final sample consisted of 20,720 participants. Among them, 12.4% of respondents (N = 2,555) reported severe or extremely severe levels of depressive symptoms, 17.6% (N = 3,627) of anxiety symptoms and 41.6% (N = 8,619) reported to feel at least moderately stressed by the situation at the DASS-21.According to the multivariate regression models, the depressive, anxiety and stress symptoms significantly worsened from the week April 9-15 to the week April 30 to May 4 (p < 0.0001). Moreover, female respondents and people with pre-existing mental health problems were at higher risk of developing severe depression and anxiety symptoms (p < 0.0001).

CONCLUSIONS

Although physical isolation and lockdown represent essential public health measures for containing the spread of the COVID-19 pandemic, they are a serious threat for mental health and well-being of the general population. As an integral part of COVID-19 response, mental health needs should be addressed.

Analysis of Necessary Support in the 2011 Great East Japan Earthquake Disaster Area

Altogether, 1588 dietitians were dispatched from the Japan Dietetic Association (JDA) to a disaster area for the first time on a nationwide scale following the 2011 Great East Japan Earthquake. Various studies have been conducted based on the activity reports, but the support that the disaster area requested was not documented. The purpose of this study is to identify the support that was needed in the disaster area. Therefore, we investigated the necessary support desired by dietitians who lived in the disaster areas. Questionnaires were sent to 1911 dietitians who were members of the JDA and lived in 3 affected prefectures in August 2012. In total, 435 dietitians (22.8%) completed the questionnaire. Among the questions on the questionnaire, we analyzed answers to the open-ended question: “Please write freely about the support that you wanted at the time of the disaster” (n = 332). Using qualitative descriptive analysis, we extracted data from the answers and categorized and labeled them into similar groups. These groups were divided into four categories: (1) “goods,” (2) “establishing a system in advance of a large-scale disaster,” (3) “information,” and (4) “human resources.” To provide “goods,” “information,” and “human resources” to the disaster area smoothly, it is important to plan a “system” in advance of large-scale disasters.